Apple, Cerner, Microsoft, and Salesforce

… all rumored to be in the mix to acquire athenahealth.


Why not?

a) Apple doesn’t do “verticals.”  It’s that easy.  Apple sells products that anyone could buy.  A teacher, a doctor, my mom.  Sure – they have sold high-end workstations that video editors can use, but so could a hobbyist filmmaker. Likelihood of Apple buying athenahealth?  ~ .01%

b) Cerner?  Nah. While (yes) they have an aging client-server ambulatory EHR that needs to be replaced by a multi-tenant SaaS product (like the one athenahealth has built), they have too much on their plate right now with DoD and VA and the (incomplete) integration of Siemens customers.  Likelihood of Cerner buying athenahealth?  ~ 1%

c) Microsoft.  Like Apple, it’s uncommon for MSFT to go “vertical.”  They have tried it. (Who remembers the Health Solutions Group?) But the tension between a strong product-focused company that meets the needs of many market segments, and a company that deeply understands the business problems of health (and health care) is too great.  The driving force of MSFT, like Apple, is to sell infrastructure to care delivery organizations.  Owning a product that competes with their key channel partners would alienate the partners – driving them to AMZN, GOOG and APPL.  Likelihood of Microsoft buying athenahealth?  ~ 2%

d) Salesforce.  I’d love to see this.  But it’s still unlikely.  athenahealth has built a product, and they (now) have defined a path to pivot the product into a platform.  This is the right thing to do.  Salesforce “gets” platform better than everyone (aside from, perhaps, Amazon).  But Salesforce has struggled with health care. They’ve declared n times in recent years that they are “in” to really disrupt health care, and with the evolution of Health Cloud, and their acquisition of MuleSoft, they have clearly made some investments here, but the EHR is not the “ERP of healthcare” as they think it is. (Salesforce’s success in other markets has been that they dovetail with – rather than replace – the ERP systems to create value and improve efficiencies.)   The way that Salesforce interacts with the market is unfamiliar (and uncomfortable) to most care delivery organizations.  So if Salesforce “gets” platform, and athenahealth wants to be a platform when it matures, could these two combine?  It’s the most likely of the three, but I still see the cultures of the two companies (I know them both well) as very different, and not quite compatible. Likelihood of Salesforce buying athenahealth?  ~ 10%


a) Phillips.   They have enough $$, are getting into population health, have IoT “last mile” business alignment, and understand the need to migrate from FFS to value on a global scale.

b) Roper / Strata.  Yeh – you didn’t think of this one! Roper owns Strata Decision.  Cost accounting fits well into the revenue cycle roots of athenahealth.  Strata is getting deeper into the role that clinical activity (and deviations from best practice) plays in cost.  Dan Michelson (Strata CEO) understands the EHR market incredibly well.

c) Amazon.  Platform.  ABC.  1492.  I’ll say no more.  If you don’t know what I’m talking about, LMGTFY.

d) Value Act.  Elliott’s not the only big player that may have interest in owning this real estate.

e) IBM. Yup. Could happen. They have made significant investments in health (and health care). Unlikely but possible.

I’m sure there are more.  This will be interesting.  athenahealth has a vibrant culture, fantastic people, a strong, devoted customer base, and an active developer community.  Remember:  this is a revenue cycle company, not an EHR company.  The EHR is a new game they’re playing.  It’s an important one, but Todd and Jonathan got into this business with the goal of solving business problems for their customers.  That vision remains.  It turns out that a healthier population is (or should be) good for business, and an EHR is (for now) part of that picture.  But as the needs of the market evolve, athenahealth will evolve.  They’ve demonstrated this well, and this agility is what will cause them to be successful in the long-term.